Last year, a proposal for Nebraska to expand Medicaid was stopped by a legislative filibuster. This year, supporters have a new proposal they say would insure about 50,000 Nebraskans. It would offer Medicaid managed care to people with income up to the federal poverty line – about $19,500 for a family of three. Between there and 138 percent of poverty – about $26,000 – the plan would use federal Medicaid dollars to help people pay private insurance premiums.

Among those advocating expansion was Sarah Gershon of Lincoln. Gershon said she makes too much to qualify for existing Medicaid, but too little to qualify for subsidies. She said she’s been diagnosed with a form of arthritis, but can’t afford testing to determine exactly what’s wrong, and therefore can’t get medication.

“Last year at this time I was able to work two jobs. I’m down to barely making it through three shifts a week. There is no way to afford medical care at that point,” Gershon said. “I’m not the only person in this position. I would be able to more than repay what I would borrow into the system once I get to the point where my health is good again. I’m asking you to consider this for people like me who don’t get help, who don’t get a handout, who just want a little help to be able to get a little bit further.”

Jim Otto of the Nebraska Restaurant Association also supported expansion. He said Nebraska businesses could be fined $11 million to $16 million a year if their employees wind up using the health exchange, and could also lose employees to other states that have expanded Medicaid. “If all it takes it takes to have health insurance is for a worker living in South Sioux City, Nebraska or Omaha, Nebraska to simply work across the river in Sioux City or Council Bluffs, Iowa, it certainly encourages ‘border bleed’ of Nebraska workers to Iowa. And the same is true of the Colorado border,” Otto said.

Gov. Dave Heineman remains opposed to Medicaid expansion. In an interview, Heineman’s director of Health and Human Services, Kerry Winterer, outlined the adminstration’s concerns. “We continue to be concerned about the cost of Medicaid expansion, and this is Medicaid expansion,” Winterer said. “But in fact it’s more expensive than what the Legislature was talking about last year. We estimate that the cost of this is about 40 percent higher than just pure Medicaid expansion.”

Winterer said this year’s plan would pay private premiums and cover additional costs like transportation, deductibles and copays. Omaha Sen. Jeremy Nordquist questioned the new cost estimate, saying earlier estimates had been reduced.

Also on Wednesday, debate continued over the Electoral College. The state Republican Party wants to end Nebraska’s system of allocating three of the state’s five electoral votes according to who wins each congressional district. But in other states like Pennsylvania, Republicans want to adopt the Nebraska plan, because it would help them there.

Omaha Sen. Brad Ashford, a former Republican and independent and now a registered Democrat in the officially nonpartisan Unicameral, said those considerations shouldn’t matter. “This for me is a vote for independence. The independence of our state, the independence of our body. I could care less about the political ramifications of the decision,” Ashford said, opposing the change.